- People with severe acne can struggle with poor self-esteem, depression, or anxiety.
- Severe acne cannot typically be treated with OTC acne treatments and must instead be addressed by a dermatologist.
- Cases of severe acne are most often treated with prescription medications and procedures over a sustained period of time.
Unlike common acne (also known as mild acne or moderate acne), which can cause minor blemishes that clear up in a matter of days or weeks, severe acne vulgaris is known to cover large areas of skin, and can also cause swelling and hardened, painful lesions.
While it can be distressing to live with severe acne, there are several effective ways of treating acne which can bring relief during outbreaks and help prevent infection, scarring or more serious emotional stress.
What Is Severe Acne?
Those suffering from severe acne tend to have many breakouts on their face, chest, back, buttocks, or along the jawline and neck. Severe acne can also appear on other parts of the body. Breakouts can consist of many blackheads, whiteheads, or both. Additionally, some experience painful below-the-skin cysts or nodules filled with pus.
Severe acne scars
Once severe acne eventually clears up, acne scars typically appear. The cysts often associated with severe acne destroy skin tissue which is not replaced once the skin heals. When facial cysts eventually drain and heal, a scar in the form of an indentation is normally left behind. On the contrary, scarring on the chest and back can be raised–also known as hypertrophic scarring.
There are numerous treatments options which can improve and soften acne scars, thus reducing their appearance. Oftentimes, a combination of treatments gets the best results. Your doctor might recommend one or more of the following treatments:
- Dermal fillers. The injection of fillers which deliver collagen or fat into any indented scars works to stretch skin or fill it out, making scarring less visible. Fillers only have temporary effects, however, so periodic injections are needed.
- Dermabrasion. This procedure removes surface scars with a rotating brush, and reduces the appearance of deeper acne scars.
- Laser skin resurfacing. Laser light breaks up scar tissue on the top layers of skin while encouraging the growth of new, healthy skin cells.
Types of Severe Acne
Severe acne may be inflammatory or non-inflammatory, the latter being a milder type, often consisting of pimples or blackheads. Inflammatory acne on the other hand refers to clogged pores infected with bacteria which have either become papules (pimples which don’t contain pus), pustules (pimples that do contain pus), or cysts. When the immune system fights back, affected skin tissue can become swollen and red.
The main types of severe acne include the following:
Inflamed cysts are what characterize cystic acne or nodulocystic acne, which are pus or fluid-filled bumps. These cysts can be up to a few centimetres large and quite painful. Cysts can occur separately or in clusters.
Acne conglobata is a rare and severe form of nodulocystic acne which most often affects young men. It occurs when large acne cysts connect below the skin to create visible and possibly even disfiguring scars. If you have nodules filled with pus which give off an odor (an early sign) it is important to treat the skin condition aggressively and early to prevent permanent scars.
Acne fulminans is associated with a spike in androgens (male sex hormones) and is characterized by sudden inflammation affecting the entire body. The condition is most common in adolescent males. Symptoms can include fever, joint pain, bleeding ulcers, weight loss and swelling of the spleen and liver. This recurrent type of severe acne should be monitored and treated over the long term by a dermatologist.
Causes of Severe Acne
The sebaceous glands secrete sebum, an oily substance meant to help protect hair follicles and skin, but overproduction of sebum can cause your pores to become clogged, creating the ideal environment for the overgrowth of P. acnes, the bacteria that causes acne. The main causes of severe acne will include one or more of the following:
The largest acne-causing factor are the hormonal changes that adolescents undergo. Throughout puberty, androgen levels rise sharply, causing an increase in sebum production. At the same time, skin cells start growing faster as well, creating the perfect conditions for clogged pores. Hormonal changes linked to acne can also be related to the menstrual cycle or pregnancy in women.
Acne can occasionally be caused or worsened by certain medications. These include hormonal medications such as oral corticosteroids, hormonal contraceptive agents like the implant, the IUD or oral contraceptives (although they can also be prescribed to treat acne), and anabolic steroids, which can cause severe acne including acne conglobata and acne fulminans.
A variety of non-hormonal medications can cause acne as well, due to their effects on the immune system; their stimulation of insulin, and any direct effects they may have on hair follicles. These may include halogens, antiepileptics, and certain antidepressants.
Although there is no specific acne gene, acne is still considered genetic. Because genes influence how your skin reacts to hormones, similar levels of androgens have different effects on people with different genetic makeups. Genes also influence the strength of your body’s inflammatory response to bacteria. Acne patients tend to have a much stronger inflammatory response to p. acnes bacteria, for instance.
Severe Acne Treatments
Typically, effective treatments for severe acne are those that take an aggressive and sustained approach. It’s always important to give your acne treatment time to work as it can take two to three months to see results
Dermatologists often recommend treating severe acne with one of the following approaches:
Over the counter topicals
There are a variety of OTC medications that can help treat severe acne. They come in the form of creams, lotions, gels, soaps and wipes. Products containing topical benzoyl peroxide and salicylic acid can be applied directly over an entire affected area. They work to remove dead skin cells, clear sebum, and kill off bacteria.
Isotretinoin, also known as Accutane, is a potent medication which attacks bacteria, clogged pores, excess oil, and acts as an anti-inflammatory–addressing all the chief causes of acne. About 85% of patients see permanent improvements after one course of treatment. Due to possible serious side effects including birth defects, depression and psychosis, those who take it are closely monitored.
A birth control pill can be an effective treatment for severe acne with hormonal causes. Your doctor might prescribe hormonal oral contraceptives alongside an antibiotic or a medication known as spironolactone to get your skin under control.
Initially created to treat high blood pressure and other cardiovascular problems, spironolactone is a medication that can also help improve hormonal acne when taken at a lower dose. It’s also an androgen blocker.
In addition to prescribed medications, your dermatologist may try different methods to remove a large cyst or nodule. For instance, they may inject it with a corticosteroid to help reduce its size and any pain it may be causing within 2 to 5 days.
Another procedure known as incision and drainage is used to drain a large, painful cyst or nodule when medication has proven ineffective. It involves the use of a sterile needle to open the blemish before removing its contents.
During another procedure known as acne extraction, a dermatologist uses sterilized equipment to clear out your pores. You may need to have your skin exfoliated beforehand. This is often shown to be effective against stubborn blackheads and whiteheads.
Treatment for severe acne in adults
Persistent acne begins in adolescence and continues into adulthood. Most adults sufferers have this type of acne. Late onset acne on the other hand, is less common, and occurs when a person develops acne for the first time as an adult.
Adult acne affects women more often than men: an estimated 35% of women and 20% of men experience acne. While all of the above-listed acne treatments are suitable for adults, birth control pills can help to bring acne under control for many adult women, and since physical and emotional stress can also affect hormone levels and cause acne breakouts in both men and women, stress reduction techniques may help as well.
At-Home Tips for Managing Severe Acne
Most people are able to manage their acne away with proper skin care and the right combination of medications or OTC topicals. Discontinued treatments can often result in the quick return of severe acne, however, hence the use of the term “manage.” It’s important to remain vigilant and committed to your acne treatments, even when you see improvements.
The following are some DIY tips for continued management of your severe acne, to be used in tandem with your other treatments:
Use a warm or cold compress
Apply ice in five to 10 minute intervals to reduce any pain and swelling as soon as it occurs. Heat, on the other hand, should be used once a whitehead begins forming. Soak a clean washcloth in hot water and apply it to the pimple for 10 to 15 minutes three to four times daily until the pus drains and the area heals.
Wash your skin gently
Use your fingertips to apply a mild, alcohol-free, fragrance-free, non-abrasive cleanser. Avoid a mesh sponge, or anything else that can irritate the skin by scrubbing. Avoid products that irritate your skin, such as astringents, toners and exfoliants.
Avoid tanning or excessive UV exposure
Tanning can damage your skin, and some acne medications make the skin extra sensitive to UV light, which you can be exposed to from tanning beds or the sun.
Do not pop or pick at your acne
Let your skin heal naturally, and resist picking, popping, or squeezing your acne, as this will only prolong your healing and increase your risk of infection and scarring. Generally, keep your hands off your face altogether.
When To See a Dermatologist
If the OTC products you’ve tried have failed, your acne is only worsening or becoming infected, and has even begun to cause scars, it is time to speak with a dermatologist. There is no reason to let severe acne affect your self-esteem or cause emotional distress. A dermatologist will, by trial and error, find the right severe acne treatment for you.
Severe acne can occur regardless of age, and can take its toll on a person’s emotional wellbeing and anxiety levels.
Severe acne may be caused by genetics, hormonal factors, or even certain medications which affect the hormones or immune function.
If you suffer from severe acne, consult a dermatologist to be paired with the right treatment(s) for you and refrain from touching or squeezing your face. Commit to a regimented yet gentle skin care routine as well.
While severe acne can be stubborn, it’s not impossible to get rid of. Thanks to advances in dermatology, most cases will see success with the help of a qualified dermatologist’s treatment plan.
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